Attention-Deficit/Hyperactivity Disorder (ADHD): Signs, Symptoms, & Treatments

What Is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurological condition that results in symptoms related to inattention, hyperactivity/impulsivity, or both.² The first signs of ADHD often manifest in childhood, and many individuals may experience negative impacts on academic, social, and adaptive abilities across their lifespans.¹

Like any mental or physical health condition, symptoms of ADHD vary depending on the person and their environment. Those with ample support may experience less impairing symptoms, while those lacking appropriate accommodations and care may struggle to manage their ADHD.

Is ADHD a Disability?

ADHD is a neurodevelopmental condition that can significantly impair functioning. In some cases, ADHD can be a disability if symptoms interfere with the ability to work. Individuals with ADHD may be legally entitled to certain protections and accommodations under the American Disabilities Act (ADA), which is in effect for companies with over 15 employees. The ADA requires workplaces and schools to offer reasonable accommodations in their settings.

How Common Is ADHD?

Attention-deficit/hyperactivity disorder is among the most common neurobehavioral disorders in children, affecting an estimated 4-12% of school-aged children worldwide.³ In addition, data suggests up to 5% of college-aged students and adults meet the criteria for ADHD.

Is ADHD More Common in Men Than Women?

ADHD is diagnosed and treated more frequently in males than females, with statistics ranging from a 2:1 to 10:1 ratio.⁴ However, this phenomenon may speak more to gender differences in presenting symptomology. Many mental health experts believe girls and women are unidentified and underdiagnosed because they exhibit more inattentive symptoms rather than hyperactivity.

ADHD Vs. ADD

ADD is an outdated term for what is now formally recognized as attention-deficit hyperactivity disorder (ADHD). In 1987, APA changed the acronym to include hyperactivity in the latest DSM revision. However, some people may still use the term ADD to describe ADHD diagnoses with predominantly inattentive features.⁵

Symptoms of ADHD

ADHD refers to a persistent pattern of inattentive, hyperactive, and/or impulsive symptoms that occur across multiple settings. ADHD typically emerges in childhood, and these symptoms may worsen or improve due to age, experience, and treatment.

Symptoms of attention-deficit/hyperactivity disorder may include:

• Being unable to sit still
• Marked restlessness (fidgeting, standing up frequently, moving around)
• Difficulty concentrating
• Disorganization
• Difficulty identifying or expressing emotions (Alexithymia)
• Acting without thinking
• Emotional outbursts or overload (sometimes called ADHD meltdowns)
• Frequently interrupting conversations
• Having a short attention span
• Chronic forgetfulness or losing things
• Frequently making seemingly careless mistakes

Types of ADHD

A person may experience predominantly inattentive, predominantly hyperactive/impulsive, or combined symptoms of ADHD. Depending on the type of ADHD, they may struggle with issues related to concentration, risky behavior, or social interactions. Because neurodiversity occurs on a spectrum, these categories provide a baseline to help professionals determine the best treatment and support plan.

The types of ADHD include:

Inattentive ADHD

Inattentive ADHD symptoms exist on a spectrum but entail a pattern of difficulty with concentration, focus, and organization. Many people believe ADHD must entail a hyperactive component, meaning those with inattentive ADHD may receive misdiagnoses. However, inattentive ADHD can be just as difficult to manage, particularly when stigmatized or undetected.

Symptoms of inattentive ADHD may include:

• Difficulty with close attention to detail across multiple contexts
• Making frequent mistakes
• Difficulty maintaining attention in non-preferred tasks or activities
• Demonstrates “wandering attention,” even without the presence of clear distractions
• Difficulty following through with tasks
• Disorganization
• Avoidance of tasks that require persistent mental effort
• Forgetfulness
• Distractibility
• Time blindness

Hyperactive/Impulsive ADHD

Individuals meeting the diagnostic criteria for hyperactive/impulsive ADHD have significant difficulty with behavioral excess. Individuals exhibiting hyperactivity or impulsivity may struggle to sit still, and many experience a seeming abundance of energy.

These symptoms are typically more overt and sometimes socially stigmatizing than difficulties with attention. For example, children with ADHD may frequently get up from their seats or fidget at their desks during class. Adults may interrupt others during conversations or blurt out their thoughts. Of course, people with ADHD rarely, if ever, behave this way with ill intent. Instead, they simply struggle with impulse control.

Symptoms of hyperactive/impulsive ADHD may include:

• Frequent fidgeting or tapping with hands or feet
• Inability to remain seated during times when expected
• Excessive motor activity (i.e., running, climbing)
• Restlessness
• Difficulty engaging in quiet leisure activities
• Excessive talking
• Speaking out of turn
• Sharing thoughts without considering the reactions of others

Combined ADHD

People with combined ADHD or ADHD combined traits exhibit both hyperactive and inattentive traits. Some believe this is the most common type of ADHD, and the frequency and intensity of the symptoms may fluctuate and evolve over time.

Signs of ADHD in Different Ages

ADHD symptoms are chronic, but their manifestation can look different across the lifespan. For example, ADHD in children tends to be more prominent in school settings, and teenagers may show signs of impulsiveness and academic problems. Adults can experience complications across multiple domains, including work, relationships, financial well-being, and physical health.

Signs of ADHD In Children

Although not exclusively specific to ADHD, children with ADHD may present with mild language, motor, or social development delays.¹ Many parents first report excessive motor activity in toddlerhood, but distinguishing typical development from hyperactivity and ADHD in toddlers children can often be difficult before age four. Most commonly, ADHD is diagnosed during elementary school years (ages five to seven) when attention problems become more impairing.

Signs of ADHD In Teens

Symptoms of impulsivity, excessive activity levels, and poor focus tend to be stable throughout early adolescence. For many individuals, hyperactive behavior lessens as they age, giving way to fidgeting, impatience, or general restlessness.

Teens with ADHD often demonstrate more educational difficulties, including lower grades and higher drop-out rates, than neurotypical adolescents. They also have more difficulty developing and maintaining relationships with peers, teachers, siblings, and parents.⁶

Signs of ADHD In Adulthood

Research suggests reduced core symptoms of ADHD in adulthood.⁷ Some symptoms of adult ADHD, such as poor planning and inattention, tend to persist throughout their lives. Older individuals may have more problems with adjustment and poorer mental health than comparison groups.

Impulsive symptoms of ADHD in adulthood can contribute to financial and legal problems, as these individuals are more likely to switch jobs, and get speeding tickets. Driving with ADHD can also result in the risk for driving accidents.

What Causes ADHD?

A solitary cause of ADHD is unknown, but experts believe a combination of factors influences development. Studies suggest those with ADHD often exhibit similar brain differences and neurotransmitter imbalances. Additionally, genetic predispositions increase the risk of ADHD.

Causes of ADHD may include:

Structural Brain Differences

MRI/FMRI studies suggest atypical brain structures among individuals with ADHD. Most notably, scans have shown overall decreases in brain volume, particularly in the prefrontal cortex, basal ganglia, cerebellum, and parietal-temporal regions.^8,9

In addition, longitudinal studies demonstrate delays in prefrontal cortical development during childhood. Researchers propose these impacted areas may contribute to delays in cognitive processing, working memory, or motor and attention planning.^8,9

Chemical Imbalances

Additional research has implicated several biological bases for the symptoms of ADHD, including deficits in the reward/motivational centers of the brain (the dopamine pathway). Brain neuroimaging studies demonstrate ADHD dopamine deficiencies or disruption in the dopamine pathway, possibly resulting in core symptoms of inattention and impulsivity.¹⁰

Genetic Factors

Previous familial research has established that childhood and adult ADHD is highly heritable, especially among first-degree relatives.¹¹ However, research into whether ADHD is genetic has not identified specific genes responsible for conferring heritability in families. ADHD is not associated with specific physical features, though subtle motor delays and neurological signs may occur.¹¹

Environmental Factors

Some environmental factors may increase the likelihood of an ADHD diagnosis, such as a low birthweight (less than three pounds. However, most children with below-average birth weight do not develop ADHD.¹¹

Additionally, research suggests connections between environmental toxins and a later ADHD diagnosis, including lead, alcohol, and nicotine exposure during pregnancy.¹¹

What Does NOT Cause ADHD

While experts have not defined a single variable that causes ADHD, they have debunked some of the harmful misconceptions associated with ADHD diagnoses. For example, some people once believed too much TV or sugar led to ADHD. Others blamed parents for being too lenient or permissible.

Factors that do not contribute to the development of ADHD include:

• TV
• Playing violent video games
• Food additives
• Certain parenting styles

Risk Factors for ADHD

Risk factors may increase the likelihood of developing ADHD, but a person with these experiences will not necessarily have ADHD. However, research has identified some notable possible contributing variables, such as low birth weight, histories of mental health disorders, and pregnancy complications.

Below are possible risk factors for ADHD:

• Brain injuries
• Low birth weight
• Premature birth
• Maternal alcohol or tobacco use during pregnancy
• Exposure to environmental toxins during pregnancy or infancy
• Having one or more relatives with ADHD
• Having another co-occurring mental health issue

Complications of ADHD

The specific side effects of ADHD differ based on individual factors and the severity of the condition. In general, ADHD can impair functioning in multiple ways. Those with ADHD may struggle with work or academic performance and face unique challenges in interpersonal relationships.

Below are possible complications of living with ADHD:

• Poor self-esteem: People with ADHD may experience low self-esteem due to embarrassment or shame about how symptoms affect their daily lives.
• Depression: Challenges associated with ADHD can be incredibly difficult to manage, sometimes leading to an increased risk of depression and negative thoughts.
• Sleep issues: Many people with ADHD also experience sleep issues, including difficulty falling asleep, restlessness at night, vivid dreams, and difficulty waking up.
• Relationship problems: ADHD can create relationship challenges, as those with the condition may forget about important anniversaries, overlook their partner’s needs, or exhibit poor follow-through.
• Academic or work issues: Inattention and distractibility can impair the ability to function well at work or school, leading to poor performance and sometimes job loss.

How to Get an ADHD Diagnosis

Qualified medical professionals diagnose attention-deficit/hyperactivity disorder in children, adolescents, and adults using ADHD DSM-5 criteria.¹ The professional will typically assess patient symptoms, severity of impairment, comorbidity (presence of other symptoms), family history, and psychosocial stressors. Pediatric evaluations often include patient and caregiver interviews, behavioral observations, and school, medical, or neuropsychological testing results.

ADHD diagnostic criteria include:

• Children under 16 exhibit six or more symptoms
• Teens and adults over 16 exhibit five or more symptoms
• Symptoms have been present for at least six months and are inappropriate for developmental level
• Symptoms first appeared before age 12
• Symptoms occur in at least two settings
• Symptoms interfere with daily life
• Other mental or physical health conditions do not cause symptoms

Tests & Scales for ADHD

ADHD assessments are comprehensive evaluations that examine a wide breadth of behaviors, symptoms, and mental health history. Ruling out differential diagnoses is important, as ADHD often coexists with other mental health symptoms.

Below are tools for diagnosing ADHD in children and adults:

• Child Behavior Checklist (CBCL): Parents complete this assessment for their children to evaluate various ADHD symptoms. The CBCL consists of 113 questions on a three-point Likert scale.
• Conners’ Rating Scales: Parents complete the Conners’ Rating Scale after a preliminary visit with a psychologist or psychiatrist.
• Teacher Rating Scale: This assessment uses a Likert scale to measure the presence and frequency of ADHD symptoms.
• Parent Rating Scale-Revised: Parents complete these scales consisting of 80 questions that assess ADHD symptoms.
• Adolescent Self-Report Scale: Adolescents frequently complete these tests consisting of 18 questions ranked using a Likert scale.
• Vanderbilt ADHD Rating Scales (VADRS): Parents for children ages six to 12 complete the VADRS by answering 55 questions with ‘never, occasionally, often, and very often.’
• Parent Rating Scale: This test assesses a child’s social, behavioral, and emotional functioning. Parents provide answers to this exam, as well.
• ADHD Rating Scale-IV (ADHD-RS-IV): Adults provide answers to this test independently.

ADHD Treatment Options

Treatment for adult ADHD often includes a combination of behavioral therapy and medication. Many children and adults with ADHD experience symptom improvements with stimulants, but some may benefit more from non-stimulants or other off-label prescriptions. Therapy can help individuals manage behavioral, social, or personal challenges associated with ADHD.

Therapy for ADHD

Therapy for ADHD can help people understand their triggers, change unwanted behaviors, and achieve better symptom management. Clients can work with therapists to develop tools for improving self-esteem, strengthening relationships, and enhancing overall life satisfaction.

For children with ADHD, parents and caregivers can provide support alongside a therapist to promote a positive parent-child relationship and mutual acceptance. Family therapy can benefit teens with ADHD, as they can learn to express both ADHD and adolescence-specific challenges in a safe environment. Adults can seek professional help to develop effective tools for navigating relationships, work problems, and goal-setting.

Here are common therapy options for ADHD:

• Cognitive behavioral therapy (CBT): CBT for ADHD focuses on the relationship between thoughts, feelings, and behaviors. Reframing or changing negative thoughts can help people improve their emotional well-being and choose adaptive behavioral responses.
• Mindfulness-based cognitive therapy (MBCT): MBCT integrates mindfulness and behavioral techniques to help individuals with ADHD remain grounded in the present. These tools can help improve distractibility, impulsivity, and other ADHD symptoms.
• Parent coaching: Parent coaching encourages parents as they learn to support their children with ADHD by focusing on integrating specific skills and engaging in positive communication patterns.
• Play therapy: For children with ADHD, play therapy can provide a calm, relaxed space to explore their challenges through play. Sometimes, communication can be difficult for young children, and many may prefer to express themselves with nonverbal interactions.
• Family therapy: Family therapy can be beneficial when ADHD affects family dynamics at home. Members learn to provide mutual support and understanding as they navigate various struggles together.

Medications for ADHD

Numerous systematic reviews show that up to 70% of children with ADHD respond well to stimulant medications, showing short-term improvement in symptoms related to inattention and hyperactivity/impulsivity.¹² However, stimulants carry the risk of misuse and dependence, so parents and adults may choose to pursue non-stimulant ADHD medications instead.

Common ADHD medication side effects include nervousness, insomnia, dry mouth, loss of appetite, and constipation. A pediatrician can prescribe these medications, but many will refer families to a specialist (i.e., psychiatrists) for ongoing medication management. You should always discuss your symptoms and medical history with a prescribing doctor to determine whether stimulants or non-stimulants are the best treatment option for you.

Medications for ADHD may include:

• Ritalin
• Quillivant
• Concerta
• Adderall
• Dexedrine
• Strattera

Can ADHD Be Cured?

While ADHD is incurable, treatment can help individuals cope with and manage symptoms. Symptoms like hyperactivity may decrease from childhood to adulthood, but ADHD does not go away with age.

Still, ADHD comes with benefits, and those with the condition can have meaningful, fulfilling lives, just like anyone else. You should not view your ADHD as something you need to change–consider exploring how you can connect with your identity to foster self-compassion and acceptance.

Living With ADHD as an Adult

ADHD is a chronic condition, and many individuals with the diagnosis face ongoing difficulties throughout their lives.(FN6) Aside from formal treatment, adults with ADHD can make positive changes to support symptom management.

Maintaining a healthy lifestyle through regular exercise, eating nutritious foods, and prioritizing sleep can help those with ADHD improve their overall well-being. Additionally, seeking social support and developing lasting, meaningful relationships can significantly enhance their quality of life and self-esteem. ADHD does not have to control your life–take your health into your own hands to build a brighter future.

Below are tips for living healthily with adult ADHD:

• Maintain regular exercise: Exercise and mental health are connected in many ways, as physical activity releases feel-good hormones to promote positive emotions and well-being. Consider engaging in regular exercise to boost dopamine levels and self-esteem.
• Eat a healthy diet: Nutrition alone will not cure ADHD but can support overall health. Physical wellness can seep into your emotional and mental health to improve various aspects of life.
• Practice healthy coping skills: Prioritize managing stress and using coping skills when overwhelmed. These tools can improve decision-making and reduce impulsivity when faced with unexpected challenges.
• Break goals into manageable steps: Indicate each step you need to take to complete the task so you stay on track. Remember to set time aside to recoup and rest as you approach difficult projects, responsibilities, or other obstacles.
• Optimize various organization strategies: Experiment with different schedules, planners, and automation systems until you find a routine that works for you. These tools support organization, task completion, and time management.

Parenting a Child With ADHD

Children thrive with loving, consistent parents who can honor their needs and set reasonable boundaries. While ADHD can be difficult to manage, parents and children work best when on the same team. Focus on remaining unconditionally accepting and supportive of your child as they learn positive coping skills, symptom management tools, and self-advocacy. Additionally, consider working with their teachers on accommodations when necessary.

Here are some helpful tips for parenting a child with ADHD:

• Stick to a schedule: A predictable routine can be paramount for children with ADHD. Knowing what to expect can help them stay on track with homework, extracurricular activities, and household chores.
• Set a designated homework area: Create a space specifically for homework and other school assignments. Your child will learn to associate this area with focus and motivation, helping them avoid distractions when working.
• Give options: Honor their autonomy by presenting them with choices. Children need some independence to develop a healthy sense of self and identity.
• Do not shame meltdowns or tantrums: Allow your child to feel their feelings. Children with ADHD often experience intense emotions, so model healthy emotional regulation to help them learn positive self-expression.
• Practice empathy and acceptance: Managing ADHD is difficult at any age, but many children have not developed the tools necessary for dealing with adult issues like emotional dysregulation and executive dysfunction. Practice patience with your child as they approach these challenges, offering support and encouragement as needed.

Are There Benefits of ADHD?

Not all ADHD characteristics and symptoms are negative. Actually, many people find embracing the benefits of ADHD helps them think outside the box, embrace creativity, and become experts in a particular subject or theme.

Positive characteristics and impacts of ADHD may include:

• Increased spontaneity
• More creativity
• Capacity for problem-solving
• Innovative thinking
• Sense of humor
• Empathy
• Enthusiasm
• High energy